When caring for Mr. Roberto’s AV shunt on his right arm, you should:
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Solution
User surgical aseptic technique when giving shunt care
To gain access to the vein and artery, an AV shunt was used for Mr. Roberto. The most serious problem with regards to the AV shunt is:
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Solution
Exsanguination
The main indicator of the need for hemodialysis is:
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Solution
Hyperkalemia
Which of the following is the most significant sign of peritoneal infection?
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Solution
Cloudy dialysate fluid
Cloudy drainage indicates bacterial activity in the peritoneum. Other signs and symptoms of infection are fever, hyperactive bowel sounds, and abdominal pain.
Option B: Swollen legs may be indicative of congestive heart failure.
Option C: Poor drainage of dialysate fluid is probably the result of a kinked catheter.
Option D: Redness at the insertion site indicates local infection, not peritonitis. However, a local infection that is left untreated can progress to the peritoneum.
The client asks whether her diet would change on CAPD. Which of the following would be the nurse’s best response?
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Solution
“Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because dialysis is constant.”
Dietary restrictions with CAPD are fewer than those with standard peritoneal dialysis because dialysis is constant, not intermittent. The constant slow diffusion of CAPD helps prevent accumulation of toxins and allows for a more liberal diet. CAPD does not work more quickly, but more consistently. Both types of peritoneal dialysis are effective.
A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it:
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Solution
Allows the client to be more independent
The major benefit of CAPD is that it frees the client from daily dependence on dialysis centers, home health care personnel, and machines for life-sustaining treatment. The independence is a valuable outcome for some people.
Option A: CAPD is costly and must be done daily.
Option D: Side effects and complications are similar to those of standard peritoneal dialysis.
The nurse helps the client with chronic renal failure develop a home diet plan with the goal of helping the client maintain adequate nutritional intake. Which of the following diets would be most appropriate for a client with chronic renal failure?
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Solution
Low protein, low sodium, low potassium
Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. Reducing sodium in the diet helps to control high blood pressure. It also keeps one from being thirsty and prevents the body from holding onto extra fluid. Too much potassium can build up when the kidneys no longer function well. It can cause an irregular heartbeat or a heart attack.
In planning teaching strategies for the client with chronic renal failure, the nurse must keep in mind the neurologic impact of uremia. Which teaching strategy would be most appropriate?
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Solution
Validating frequently the client’s understanding of the material.
Uremia can cause decreased alertness, so the nurse needs to validate the client’s comprehension frequently.
Option A: Because the client’s ability to concentrate is limited, short lesions are most effective.
Option C: If family members are present at the sessions, they can reinforce the material.
Option D: Written materials that the client can review are superior to videotapes, because the clients may not be able to maintain alertness during the viewing of the videotape.
The client with chronic renal failure tells the nurse he takes magnesium hydroxide (milk of magnesia) at home for constipation. The nurse suggests that the client switch to psyllium hydrophilic mucilloid (Metamucil) because:
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Solution
MOM can cause magnesium toxicity
Magnesium is normally excreted by the kidneys. When the kidneys fail, magnesium can accumulate and cause severe neurologic problems.
Option B: MOM is harsher than Metamucil, but magnesium toxicity is a more serious problem.
Option C: A client may find both MOM and Metamucil unpalatable.
Option D: MOM is not high in sodium.
The nurse teaches the client with chronic renal failure when to take the aluminum hydroxide gel. Which of the following statements would indicate that the client understands the teaching?
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Solution
“I’ll take it with meals and bedtime snacks.”
Aluminum hydroxide gel is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks.
Option A: There is no need for the client to take it on a 24-hour schedule.
Options B and C: It is not administered to treat hyperacidity in clients with CRF and therefore is not prescribed between meals.
Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is the purpose of giving this drug to a client with chronic renal failure?
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Solution
To bind phosphorus in the intestine
A client in renal failure develops hyperphosphatemia that causes a corresponding excretion of the body’s calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion.
Option A: Gastric hyperacidity is not necessarily a problem associated with chronic renal failure.
Options B and D: Antacids will not prevent Curling’s stress ulcers and do not affect metabolic acidosis.
Which of the following nursing interventions should be included in the client’s care plan during dialysis therapy?
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Solution
Monitor the client’s blood pressure
Because hypotension is a complication of peritoneal dialysis, the nurse records intake, and output, monitors VS, and observes the client’s behavior.
Option A: The nurse also encourages visiting and other diversional activities.
Options C and D: A client on PD does not need to be placed in bed with padded side rails or kept NPO.
During the client’s dialysis, the nurse observes that the solution draining from the abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. Which interpretation of this observation would be correct?
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Solution
Bleeding indicates abdominal blood vessel damage
Because the client has a permanent catheter in place, blood tinged drainage should not occur. Persistent blood tinged drainage could indicate damage to the abdominal vessels, and the physician should be notified.
Option C: The bleeding is originating in the peritoneal cavity, not the kidneys.
Option D: Too rapid infusion of the dialysate can cause pain.
The dialysis solution is warmed before use in peritoneal dialysis primarily to:
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Solution
Encourage the removal of serum urea.
The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal vessels, which increases urea clearance.
Options B and D: The warmed solution does not force potassium into the cells or promote abdominal muscle relaxation.
Option C: Warmed dialyzing solution also contributes to client comfort by preventing chilly sensations, but this is a secondary reason for warming the solution.
What is the primary disadvantage of using peritoneal dialysis for long-term management of chronic renal failure?
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Solution
It is a time-consuming method of treatment.
The disadvantages of peritoneal dialysis in the long-term management of chronic renal failure is that requires large blocks of time.
Options A and D: The risk of hemorrhage or hepatitis is not high with PD.
Option B: PD is effective in maintaining a client’s fluid and electrolyte balance.